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    <div id="content">
        <h1>
            Diabetes mellitus</h1>
        <h5 class="updated">
            Last updated: Saturday, 27, November, 2010</h5>
        <table cellpadding="0" cellspacing="0" class="two-column-process">
            <thead>
                <tr>
                    <th>
                        Key Information</th>
                    <th class="description">
                        Appropriate Tests</th>
                </tr>
            </thead>
            <tr class="odd">
                <td class="first">
                </td>
                <td class="second">
                    <p>
                        Laboratory diagnosis is usually based on measurement of <b>fasting or random (&gt;2 
                        hours post-prandial) glucose in plasma.</b></p>
                    <p>
                        <b>Glucose tolerance test</b> is indicated when results are equivocal or to 
                        establish the diagnosis of gestational diabetes.</p>
                    <p>
                        The <b>glucose challenge test</b> is used to screen for gestational diabetes; 
                        see&nbsp;<a 
                            href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=58&amp;Itemid=27" 
                            target="_blank">Antenatal screening</a>.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <b>Monitoring (control)</b></p>
                </td>
                <td class="second">
                    <p>
                        <b>Glucose test strips</b>, usually done by patient.</p>
                    <p>
                        <b>Glycated haemoglobin</b> to assess control over the previous 3 months.</p>
                    <p>
                        <b>Fructosamine</b> is&nbsp;rarely used, giving an indication of control over the 
                        previous 3 weeks.</p>
                    <p>
                        For insulin-dependent diabetes, <b>urinalysis for ketones</b> should also be 
                        performed.</p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <b>Acutely ill diabetic, including</b></td>
                <td class="second">
                    <p>
                        <b>Glucose, electrolytes, anion gap, urea, creatinine.</b></p>
                    <p>
                        <b>Blood gases, hydroxybutyrate, lactate, FBC</b> if indicated.</p>
                    <p>
                        Osmolality can be calculated; direct measurement is not required.</p>
                    <p>
                        The possibility of underlying infection should be considered, especially urinary 
                        tract infection.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <i>Hyperglycaemia</i></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li>Ketoacidosis</li>
                    </ul>
                </td>
                <td class="second">
                    <p>
                        Patients with ketoacidosis may not have severe hyperglycaemia.</p>
                    <p>
                        If lactic acidosis is present, urine ketone tests may underestimate the degree 
                        of ketoacidosis.</p>
                    <p>
                        Frequent monitoring of glucose and electrolytes, esp potassium, is required.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Hyperosmolar non-ketotic coma</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <i>Hypoglycaemia</i></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <strong>Long-term consequences</strong></td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    Diabetic nephropathy</td>
                <td class="second">
                    <p>
                        <b>Albumin - urine</b> (“microalbuminuria”) for early detection of nephropathy.</p>
                    <p>
                        <b>Urine microscopy and urinalysis.</b></p>
                    <p>
                        <b>Creatinine, urea.</b></p>
                    <p>
                        <b>Renal biopsy</b> if considered appropriate.</p>
                    <p>
                        See also&nbsp;<a 
                            href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=479&amp;Itemid=27" 
                            target="_blank">Nephrotic syndrome</a>,&nbsp;<a 
                            href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=523&amp;Itemid=27" 
                            target="_blank">Renal failure - chronic</a>.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Diabetic retinopathy</p>
                    <p>
                        Cataracts</p>
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=341&amp;Itemid=27" 
                            target="_blank">Hyperlipidaemia</a></p>
                    <p>
                        Peripheral Neuropathy</p>
                    <p>
                        Peripheral vascular disease</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Infection</p>
                </td>
                <td class="second">
                    See&nbsp;<a 
                        href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=365&amp;Itemid=27" 
                        target="_blank">Immunodeficiency</a>&nbsp;- secondary and&nbsp;<a 
                        href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=369&amp;Itemid=27" 
                        target="_blank">Infection (increased susceptibility)</a>.</td>
            </tr>
            <tr>
                <td class="first">
                    <ul>
                        <li>Urinary tract infection</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=100&amp;Itemid=27" 
                                target="_blank">Candidiasis</a></li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=525&amp;Itemid=27" 
                            target="_blank">Renal papillary necrosis</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <strong>Pregnancy and neonatal complications</strong></td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Difficult control</p>
                </td>
                <td class="second">
                    Management requirements change during pregnancy; monitoring may be required more 
                    frequently.</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Fetal macrosomia</p>
                </td>
                <td class="second">
                    Birth of a disproportionately large baby is an indication for careful maternal 
                    assessment for diabetes during subsequent pregnancies and is associated with an 
                    increased risk of diabetes in later life.</td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Fetal abnormalities</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Neural tube defects</p>
                </td>
                <td class="second">
                    <b>Plasma alpha fetoprotein</b> at 14-16 weeks gestation; <b>amniotic fluid 
                    alpha fetoprotein</b> if plasma level is increased and fetal abnormality has not 
                    been identified on ultrasound.</td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Spontaneous abortion</p>
                    <p>
                        Fetal death</p>
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=531&amp;Itemid=27" 
                            target="_blank">Respiratory distress syndrome</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd-last">
                <td class="first">
                    <p>
                        Neonatal hypoglycaemia</p>
                </td>
                <td class="second">
                    Observation and <b>blood glucose monitoring</b> of neonate</td>
            </tr>
        </table>
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            <h2>
                Glossary Terms</h2>
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                <h4>
                    sp :</h4>
                <p>
                    Species</p>
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